Rating of Everyday Arm-Use in the Community and Home (REACH) Scale for Capturing Affected Arm-Use after Stroke: Development, Reliability, and Validity

OBJECTIVE To develop a brief, valid and reliable tool [the Rating of Everyday Arm-use in the Community and Home (REACH) scale] to classify affected upper limb use after stroke outside the clinical setting. METHODS Focus groups with clinicians, patients and caregivers (n = 33) and a literature review were employed to develop the REACH scale. A sample of community-dwelling individuals with stroke was used to assess the validity (n = 96) and inter-rater reliability (n = 73) of the new scale. RESULTS The REACH consists of separate scales for dominant and non-dominant affected upper limbs, and takes five minutes to administer. Each scale consists of six categories that capture 'no use' to 'full use'. The intraclass correlation coefficient and weighted kappa for inter-rater reliability were 0.97 (95% confidence interval: 0.95-0.98) and 0.91 (0.89-0.93) respectively. REACH scores correlated with external measures of upper extremity use, function and impairment (rho = 0.64-0.94). CONCLUSIONS The REACH scale is a reliable, quick-to-administer tool that has strong relationships to other measures of upper limb use, function and impairment. By providing a rich description of how the affected upper limb is used outside of the clinical setting, the REACH scale fills an important gap among current measures of upper limb use and is useful for understanding the long term effects of stroke rehabilitation.